Support Coordination Agency Selection Form - CAUNJ

Support Coordination Agency Selection Form

In order to access services funded by the New Jersey Division of Developmental Disabilities, you will need to have a Support Coordination Agency (SCA).

 

You may find potential SCAs through the Provider Search Database at https://irecord.dhs.state.nj.us/providersearch, using the following four steps: (1) under Filter, select “Service” and check Support Coordination; (2) select “Medicaid Approved” and check the box; (3) select “County Served” and select the county in which the individual resides; and (4) click the magnifying glass. If you do not have a preference, you can choose to have the Division auto-assign one to you.

 

A Guide to assist individuals and families in choosing a Support Coordination Agency is also available at https://rwjms.rutgers.edu/boggscenter/products/SelectingandEvaluatingSupportCoordinationAgency.html

 

 

Preferred Option:

Email completed form to

DDD.SCAChoice@dhs.state.nj.us

                                                                                                                  -OR-

Mail the completed form to:

New Jersey Division of Developmental Disabilities
Central Office c/o SCA Selection Forms
PO Box 726

Trenton, NJ 08625-0700

 

  • MM slash DD slash YYYY
  • Please indicate if any of the following apply

  • MM slash DD slash YYYY
  • Please indicate your choice of SCA OR auto-assign option

    We encourage that two SCA’s be provided to improve your chances of being assigned to an agency of your choice. If the agency you choose does not provide services within your county, or does not have the capacity to provide you with services at this time, you will be auto assigned.
  • *Please be aware that Support Coordination Agencies cannot guarantee, nor are they required to, assign your preferred Support Coordinator.
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Share:



EnglishSpanish